1 00:00:00,480 --> 00:00:02,659 This is Alan Condon with the Becker's 2 00:00:02,960 --> 00:00:04,259 ASC Podcast, 3 00:00:04,639 --> 00:00:07,040 and I'm thrilled to be joined today by 4 00:00:07,040 --> 00:00:09,220 Angie Jimenez, the CEO 5 00:00:09,679 --> 00:00:11,939 of Puerto Rico ASC Holding, 6 00:00:12,240 --> 00:00:15,714 which I believe manages three ambulatory surgery centers. 7 00:00:16,255 --> 00:00:18,015 Angie, a real pleasure to have you on 8 00:00:18,015 --> 00:00:20,414 the podcast with us today. Delighted to dive 9 00:00:20,414 --> 00:00:21,934 into this discussion and hear a little bit 10 00:00:21,934 --> 00:00:23,795 more about your you and your company. 11 00:00:24,175 --> 00:00:25,934 But before we do, can you kind of 12 00:00:25,934 --> 00:00:27,614 give us a little bit more insight into 13 00:00:27,614 --> 00:00:30,149 your role and your background at Puerto Rico 14 00:00:30,149 --> 00:00:31,050 ASC Holding? 15 00:00:32,469 --> 00:00:34,869 Sure, Alan. First, thank you a lot for 16 00:00:34,869 --> 00:00:35,689 having me, 17 00:00:36,149 --> 00:00:38,090 here with you. It's a real pleasure. 18 00:00:39,350 --> 00:00:42,170 Again, I will I will do a short 19 00:00:42,229 --> 00:00:42,729 disclosure. 20 00:00:43,350 --> 00:00:45,744 English is not my first language, but I 21 00:00:45,744 --> 00:00:47,424 will try to do my best. So sorry 22 00:00:47,424 --> 00:00:48,244 my pronunciation. 23 00:00:49,184 --> 00:00:51,524 As you mentioned, my name is Angie Jimenez 24 00:00:51,664 --> 00:00:54,304 Gonzalez, and I serve as the CEO and 25 00:00:54,304 --> 00:00:56,484 administrator of Puerto Rico Ambulatory 26 00:00:56,945 --> 00:00:57,924 Holding Company. 27 00:00:58,590 --> 00:01:01,250 I start my professional career as an ophthalmic 28 00:01:01,310 --> 00:01:04,530 technician. So I'm very passionate about eye surgery. 29 00:01:05,230 --> 00:01:08,109 Later I finished a bachelor degree in health 30 00:01:08,109 --> 00:01:10,290 sciences with a concentration in administration 31 00:01:11,069 --> 00:01:13,810 and began working as a clinical instructor 32 00:01:14,295 --> 00:01:17,015 in the School of Health Related Professional at 33 00:01:17,015 --> 00:01:19,334 the Medical Sciences Campus in the University of 34 00:01:19,334 --> 00:01:20,075 Puerto Rico. 35 00:01:20,614 --> 00:01:23,334 While I was working there, I complete a 36 00:01:23,334 --> 00:01:25,754 master degree in public health education 37 00:01:26,454 --> 00:01:29,114 and also I meet my current employer. 38 00:01:29,799 --> 00:01:33,020 I start my role managing a LASIK center. 39 00:01:33,400 --> 00:01:36,439 And from there, twenty years ago, the idea 40 00:01:36,439 --> 00:01:39,260 of developing an outstanding ASC was born, 41 00:01:39,719 --> 00:01:41,959 and I was asked to complete a master 42 00:01:41,959 --> 00:01:44,534 degree in health service administration to become a 43 00:01:44,534 --> 00:01:47,655 licensed administrator and be in charge of that 44 00:01:47,655 --> 00:01:48,155 development. 45 00:01:48,855 --> 00:01:51,355 So at Puerto Rico SC, my major responsibility 46 00:01:51,734 --> 00:01:54,454 is growth and oversee the operation of our 47 00:01:54,454 --> 00:01:57,840 network. Currently, we have three ambulatory surgical centers 48 00:01:58,319 --> 00:02:01,060 and collectively we are supported by a talented 49 00:02:01,200 --> 00:02:03,219 team of 100 surgeons, 50 00:02:03,519 --> 00:02:04,340 10 anesthesiologists, 51 00:02:04,959 --> 00:02:06,479 and 110 52 00:02:06,479 --> 00:02:06,979 dedicated 53 00:02:07,280 --> 00:02:07,780 employees. 54 00:02:08,479 --> 00:02:09,759 Let me talk to you a little bit 55 00:02:09,759 --> 00:02:11,300 about our three centers. 56 00:02:11,759 --> 00:02:13,459 Our first center is VISTA. 57 00:02:13,844 --> 00:02:17,284 It's a single specialty ophthalmic facility with four 58 00:02:17,284 --> 00:02:17,784 ORs. 59 00:02:18,485 --> 00:02:21,864 VISTA perform eleven thousand cases a year annually. 60 00:02:22,405 --> 00:02:25,144 The second center is named CALMA. 61 00:02:25,604 --> 00:02:28,004 It was acquired last year and is a 62 00:02:28,004 --> 00:02:28,905 multi specialty 63 00:02:29,290 --> 00:02:30,669 facility with two hours 64 00:02:30,969 --> 00:02:32,110 currently focused 65 00:02:32,569 --> 00:02:33,710 mainly on ophthalmology 66 00:02:34,169 --> 00:02:36,189 and some pain management procedures. 67 00:02:36,810 --> 00:02:39,770 We have grown its facility to 3,000 cases 68 00:02:39,770 --> 00:02:41,870 by the end of twenty twenty four. 69 00:02:42,514 --> 00:02:44,055 And here we are working 70 00:02:44,354 --> 00:02:46,675 for a full remodelation of the facility to 71 00:02:46,675 --> 00:02:48,914 develop a new AR, bringing the center with 72 00:02:48,914 --> 00:02:51,334 a total of OR to three. 73 00:02:51,875 --> 00:02:54,914 And our third facility is Kawas ASC. It's 74 00:02:54,914 --> 00:02:57,334 a state of the art multi specialty center 75 00:02:57,730 --> 00:03:00,689 with six ORs offering services across, 76 00:03:01,250 --> 00:03:01,750 ophthalmology, 77 00:03:02,770 --> 00:03:03,270 ENT, 78 00:03:03,969 --> 00:03:04,469 urology, 79 00:03:05,090 --> 00:03:05,590 podiatry 80 00:03:05,890 --> 00:03:06,629 and orthopedics. 81 00:03:07,650 --> 00:03:10,469 Here what sets us apart is our 82 00:03:11,245 --> 00:03:13,985 pioneer ambulatory total joint replacement program. 83 00:03:14,525 --> 00:03:17,405 Actually we are the first and only ASC 84 00:03:17,405 --> 00:03:19,584 in Puerto Rico performing those procedures. 85 00:03:20,284 --> 00:03:24,205 This facility, Kawas ASC performed over 7,000 cases 86 00:03:24,205 --> 00:03:26,650 last year and the total joint replacement 87 00:03:27,030 --> 00:03:30,389 program since its inception three years ago has 88 00:03:30,389 --> 00:03:32,629 performed more than 1,600 89 00:03:32,629 --> 00:03:33,129 cases. 90 00:03:33,509 --> 00:03:34,490 So that's basically, 91 00:03:35,270 --> 00:03:37,750 my background and my role at Puerto Rico 92 00:03:37,750 --> 00:03:38,250 ISE. 93 00:03:38,925 --> 00:03:40,844 Yeah. Fantastic. No. Thank you so much for 94 00:03:40,844 --> 00:03:42,764 the breakdown, not just of of your role, 95 00:03:42,764 --> 00:03:44,444 but also your makeup of your company as 96 00:03:44,444 --> 00:03:47,245 well. So really, really busy by the sounds 97 00:03:47,245 --> 00:03:49,905 of things. But between those three different ASCs, 98 00:03:50,284 --> 00:03:52,659 a hundred surgeons, I believe you said 10 99 00:03:52,659 --> 00:03:53,159 anesthesiologists, 100 00:03:54,099 --> 00:03:56,439 numerous employees as well, and perform thousands 101 00:03:56,819 --> 00:03:59,560 of cases a year between those three centers. 102 00:04:00,180 --> 00:04:02,419 It sounds like a very busy, very challenging, 103 00:04:02,419 --> 00:04:03,799 but exciting operation, 104 00:04:04,099 --> 00:04:04,599 Angie. 105 00:04:05,459 --> 00:04:07,799 Do you mind talking to me about 106 00:04:08,205 --> 00:04:10,284 what are kind of the two or three 107 00:04:10,284 --> 00:04:11,745 kind of key trends 108 00:04:12,205 --> 00:04:15,164 that you're paying most attention to in the 109 00:04:15,164 --> 00:04:17,345 a s ASC space today? 110 00:04:19,564 --> 00:04:20,064 Sure. 111 00:04:20,769 --> 00:04:23,250 For sure, it is. My my job is 112 00:04:23,250 --> 00:04:23,750 super, 113 00:04:24,689 --> 00:04:27,089 funny. I enjoy my my I work and 114 00:04:27,089 --> 00:04:29,569 and I love what I do. So seems 115 00:04:29,569 --> 00:04:32,449 to be busy, but I'm I'm truly happy 116 00:04:32,449 --> 00:04:34,610 about having a lot of people that helps 117 00:04:34,610 --> 00:04:36,925 doing our our job. So, yeah, it's it's 118 00:04:36,925 --> 00:04:39,425 it's very funny and very and very excited. 119 00:04:40,205 --> 00:04:42,444 Regarding the trends that you are mentioning that 120 00:04:42,444 --> 00:04:43,425 we are following, 121 00:04:44,764 --> 00:04:46,925 I think that the health care industry is 122 00:04:46,925 --> 00:04:50,430 evolving at an unprecedented pace and several trends 123 00:04:50,490 --> 00:04:52,990 are capturing my attention. I will set first, 124 00:04:53,689 --> 00:04:56,810 of course, the shift toward outpatient care. We 125 00:04:56,810 --> 00:04:57,310 know, 126 00:04:57,770 --> 00:04:59,310 that advances in technology, 127 00:04:59,930 --> 00:05:00,430 anesthesia, 128 00:05:00,730 --> 00:05:02,029 and surgical techniques, 129 00:05:02,735 --> 00:05:05,935 are enabling more complex procedure to transitioning from 130 00:05:05,935 --> 00:05:07,154 hospital to ASC. 131 00:05:07,694 --> 00:05:10,675 We are currently exploring the integration of cardiovascular 132 00:05:11,134 --> 00:05:14,175 and spine procedures into a four facility that 133 00:05:14,175 --> 00:05:15,954 we are developing right now. 134 00:05:16,620 --> 00:05:18,000 A multi special DIC 135 00:05:18,620 --> 00:05:22,300 designated with a hospitality component to attract medical 136 00:05:22,300 --> 00:05:23,360 tourism patients. 137 00:05:25,020 --> 00:05:27,100 I will say that another trend that I'm 138 00:05:27,100 --> 00:05:27,600 looking, 139 00:05:28,300 --> 00:05:30,319 closely is the workforce 140 00:05:30,745 --> 00:05:31,245 challenge. 141 00:05:32,264 --> 00:05:35,144 As in the state, the shortage of skilled 142 00:05:35,144 --> 00:05:35,964 health care professionals, 143 00:05:36,345 --> 00:05:38,604 including nurses and surgical technicians, 144 00:05:39,785 --> 00:05:42,125 remain a significant challenge to us. 145 00:05:42,584 --> 00:05:44,925 Here to address these, we have implemented 146 00:05:45,839 --> 00:05:48,339 strategies like offering competitive pays, 147 00:05:48,800 --> 00:05:49,300 scholarships, 148 00:05:50,000 --> 00:05:53,600 flexible scales, and fostering a supportive work culture 149 00:05:53,600 --> 00:05:54,420 to retain 150 00:05:54,800 --> 00:05:56,339 our top talent personnel. 151 00:05:57,360 --> 00:05:59,600 And I will say that the third will 152 00:05:59,600 --> 00:06:00,100 be, 153 00:06:00,904 --> 00:06:02,925 the adoption of artificial intelligence. 154 00:06:04,665 --> 00:06:07,785 I think artificial intelligence is transforming the industry 155 00:06:07,785 --> 00:06:10,665 and particularly in areas like medical billing and 156 00:06:10,665 --> 00:06:11,964 revenue cycle management. 157 00:06:12,629 --> 00:06:17,189 It's streamlined process, reduced errors, enhanced efficiency, allowing 158 00:06:17,189 --> 00:06:19,669 facilities to focus on what really cares, you 159 00:06:19,669 --> 00:06:21,689 know, is the is the patient care. 160 00:06:22,069 --> 00:06:23,769 So even though we have not 161 00:06:24,069 --> 00:06:26,250 adopted any of this, technology 162 00:06:26,629 --> 00:06:29,105 yet, We are very vigilant to these updates 163 00:06:29,105 --> 00:06:31,105 on on this matter. I will say that 164 00:06:31,105 --> 00:06:32,324 will be the three things. 165 00:06:32,944 --> 00:06:35,345 Yeah. I think I think one kind of 166 00:06:35,345 --> 00:06:37,745 follow-up question that I'd be really interested in 167 00:06:37,745 --> 00:06:39,425 and no doubt our our listeners would be 168 00:06:39,425 --> 00:06:41,425 interested in is when you'd mentioned about, 169 00:06:42,439 --> 00:06:44,540 medical tourism patients, I believe 170 00:06:45,000 --> 00:06:46,220 what what specialties 171 00:06:46,919 --> 00:06:49,819 would those medical tourism patients be most interested 172 00:06:49,879 --> 00:06:51,879 in? Kind of can you share how you're 173 00:06:51,879 --> 00:06:54,615 planning to attract more medical tourism patients? Do 174 00:06:54,615 --> 00:06:56,935 they come primarily from The US, Canada, or 175 00:06:56,935 --> 00:06:59,035 other countries? Be curious to hear about that. 176 00:07:01,095 --> 00:07:04,314 Yes. We are focusing on orthopedic patients, 177 00:07:05,014 --> 00:07:05,514 basically, 178 00:07:05,975 --> 00:07:08,314 because of our joint replacement program. 179 00:07:09,539 --> 00:07:12,259 Actually, we are super about we are super 180 00:07:12,259 --> 00:07:15,620 excited about a recent strategic alliance that we 181 00:07:15,620 --> 00:07:17,720 did with the Medical Tourism Association 182 00:07:18,500 --> 00:07:21,379 and the launch of a platform. It's the 183 00:07:21,379 --> 00:07:24,120 name of the platform is Better Platform in 184 00:07:24,295 --> 00:07:25,435 partnership with Mastercard. 185 00:07:26,455 --> 00:07:27,995 And within that is a significant 186 00:07:28,375 --> 00:07:31,335 milestone for all because we are hoping this 187 00:07:31,335 --> 00:07:33,275 collaboration position Puerto Rico 188 00:07:33,654 --> 00:07:36,074 as a premier destination for medical tourism 189 00:07:37,069 --> 00:07:40,430 patients from the mainline and from the Caribbean 190 00:07:40,430 --> 00:07:40,930 Islands. 191 00:07:41,470 --> 00:07:41,970 Mhmm. 192 00:07:42,430 --> 00:07:44,670 Interesting. Okay. That that's certainly, 193 00:07:44,990 --> 00:07:47,569 an exciting and interesting aspect of your ASC. 194 00:07:48,110 --> 00:07:50,350 What are you most excited about, Angie, when 195 00:07:50,350 --> 00:07:52,485 you think about, the future of your company 196 00:07:53,044 --> 00:07:53,544 ASCs? 197 00:07:55,044 --> 00:07:56,104 Yeah. Of course. 198 00:07:56,564 --> 00:07:59,284 I will say it again, this this, strategic 199 00:07:59,284 --> 00:08:01,685 alliance with the Medical Tourism Association, we are 200 00:08:01,685 --> 00:08:04,485 very excited about that. And we are also 201 00:08:04,485 --> 00:08:07,464 focused in the development of our fourth center, 202 00:08:07,829 --> 00:08:09,050 Santurce ASC. 203 00:08:09,669 --> 00:08:10,649 It would be 204 00:08:11,269 --> 00:08:12,329 a multi specialty 205 00:08:12,629 --> 00:08:14,009 facility that will 206 00:08:14,790 --> 00:08:17,350 turn us as the great manager in Puerto 207 00:08:17,350 --> 00:08:18,649 Rico of different facilities. 208 00:08:19,110 --> 00:08:21,269 And we are also exploring new merger and 209 00:08:21,269 --> 00:08:21,769 acquisitions 210 00:08:22,149 --> 00:08:24,324 opportunities both within Puerto Rico 211 00:08:24,785 --> 00:08:27,685 and beyond to continue expanding our our network. 212 00:08:28,944 --> 00:08:31,764 Fantastic. And that kind of ties directly into 213 00:08:32,065 --> 00:08:34,544 my last question here. It sounds like to 214 00:08:34,544 --> 00:08:36,920 you to your point, you you're very busy, 215 00:08:36,920 --> 00:08:39,160 but you absolutely love it. Busy is great. 216 00:08:39,160 --> 00:08:41,399 You work with a fantastic team of people 217 00:08:41,399 --> 00:08:43,740 around you. It sounds like orthopedics, 218 00:08:44,440 --> 00:08:44,940 cardiovascular 219 00:08:45,559 --> 00:08:47,820 care. You're working on your fourth, 220 00:08:48,404 --> 00:08:50,644 ASC, I believe you said as well. Medical 221 00:08:50,644 --> 00:08:52,264 tourism is a big component. 222 00:08:52,964 --> 00:08:54,725 How are you thinking about a lot of 223 00:08:54,725 --> 00:08:57,044 growth there already, but how are you thinking 224 00:08:57,044 --> 00:08:59,845 about growth of twelve months? Is there anything 225 00:08:59,845 --> 00:09:01,625 else you want to expand on there? 226 00:09:03,379 --> 00:09:05,240 Yes. I mean, I will say that, 227 00:09:06,420 --> 00:09:09,139 our growth strategy over the next year, I 228 00:09:09,139 --> 00:09:11,240 will say that it's focused on three areas, 229 00:09:11,860 --> 00:09:13,160 expanding our services, 230 00:09:13,779 --> 00:09:15,559 enhancing patient outcomes, 231 00:09:16,115 --> 00:09:18,274 and positioning Puerto Rico as a leader in 232 00:09:18,274 --> 00:09:21,735 medical tourism. For example, for expanding our services, 233 00:09:22,514 --> 00:09:24,194 I already told you that we are working 234 00:09:24,194 --> 00:09:25,875 on our first third of the art, 235 00:09:26,754 --> 00:09:27,254 development. 236 00:09:28,034 --> 00:09:28,774 This facility, 237 00:09:29,629 --> 00:09:32,029 we are we are targeting to to include 238 00:09:32,029 --> 00:09:35,230 the cardiovascular and spine procedure for offering patient 239 00:09:35,230 --> 00:09:38,049 advanced care that is, you know, traditionally traditionally 240 00:09:38,350 --> 00:09:39,889 available mainly at hospital. 241 00:09:40,830 --> 00:09:42,629 And of course, we are looking into adding 242 00:09:42,629 --> 00:09:43,889 the hospitality component to 243 00:09:47,305 --> 00:09:48,524 tourism patients. 244 00:09:49,785 --> 00:09:52,605 Also at Kawas ISD, one of our centers, 245 00:09:53,705 --> 00:09:55,245 we are we are working into 246 00:09:55,625 --> 00:09:57,085 adding an extra OR. 247 00:09:57,450 --> 00:09:58,970 So at the end of the year, we 248 00:09:58,970 --> 00:10:01,470 hope to end with seven ORs. 249 00:10:01,850 --> 00:10:02,910 And at CALMA, 250 00:10:03,450 --> 00:10:05,550 one other of the center, we are working 251 00:10:05,850 --> 00:10:08,250 for developing an extra OR also to bring 252 00:10:08,250 --> 00:10:10,429 the facility to three ORs. So in summary, 253 00:10:10,889 --> 00:10:12,914 we are managing right now 12 254 00:10:13,315 --> 00:10:15,095 ORs between the three centers. 255 00:10:15,554 --> 00:10:17,634 And in the next twelve months, we will 256 00:10:17,634 --> 00:10:18,454 have over 257 00:10:18,995 --> 00:10:19,495 14 258 00:10:20,115 --> 00:10:23,975 facilities and hopefully six under development with this 259 00:10:24,355 --> 00:10:25,095 new center. 260 00:10:26,120 --> 00:10:29,500 The other area, which is enhancing our patients' 261 00:10:29,559 --> 00:10:30,860 outcome by straightening 262 00:10:31,799 --> 00:10:33,820 the total joint replacement program, 263 00:10:35,639 --> 00:10:38,440 for us this pioneer program will remain the 264 00:10:38,440 --> 00:10:40,059 centerpiece of our growth. 265 00:10:40,725 --> 00:10:43,144 We aim to obtain additional 266 00:10:43,845 --> 00:10:45,784 standing with the program certification 267 00:10:46,725 --> 00:10:50,565 and increase our volume while maintaining exceptional outcomes 268 00:10:50,565 --> 00:10:51,704 and patient satisfaction 269 00:10:52,325 --> 00:10:54,644 that has made it a benchmark here in 270 00:10:54,644 --> 00:10:56,769 Puerto Rico Science. We are the only facility 271 00:10:56,769 --> 00:10:58,950 doing this in the ambulatory field. 272 00:10:59,570 --> 00:11:00,950 And I will say that, 273 00:11:01,490 --> 00:11:03,889 for growing in the next twelve months, we 274 00:11:03,889 --> 00:11:04,370 are, 275 00:11:05,169 --> 00:11:08,070 building this strategic partnership with Mastercard. 276 00:11:08,785 --> 00:11:11,345 Sorry. With the Medical Tourism Association in collaboration 277 00:11:11,345 --> 00:11:12,085 with Mastercard, 278 00:11:13,424 --> 00:11:15,205 we will focus to leveraging 279 00:11:15,665 --> 00:11:18,785 this alliance to attract international patients and further 280 00:11:18,785 --> 00:11:20,865 establish Puerto Rico, as I mentioned before, as 281 00:11:20,865 --> 00:11:22,884 a premier destination for high quality 282 00:11:23,409 --> 00:11:23,909 surgical 283 00:11:24,370 --> 00:11:27,090 care. Mhmm. It sounds like certainly a lot 284 00:11:27,090 --> 00:11:29,830 going on. A very exciting time certainly, 285 00:11:30,289 --> 00:11:32,450 for you and your team. I I know 286 00:11:32,450 --> 00:11:34,370 I said last question, but I had one 287 00:11:34,370 --> 00:11:36,769 last last question. I promise that's what I'm 288 00:11:36,769 --> 00:11:37,830 talking about. 289 00:11:38,769 --> 00:11:41,144 I I think think we I imagine with 290 00:11:41,144 --> 00:11:44,024 with the opening of this, new ASC, these 291 00:11:44,024 --> 00:11:46,504 new OORs, no doubt you'll be adding more 292 00:11:46,504 --> 00:11:47,964 physicians, more surgeons. 293 00:11:48,504 --> 00:11:51,004 I think one challenge that we hear from 294 00:11:51,559 --> 00:11:54,039 ASCs, particularly within the on the Mainland in 295 00:11:54,039 --> 00:11:56,279 The US, is how difficult they have found 296 00:11:56,279 --> 00:11:57,899 it recently to attract, 297 00:11:58,519 --> 00:11:59,740 retain some of these 298 00:12:00,440 --> 00:12:03,259 latest and greatest physicians coming out of fellowships 299 00:12:03,320 --> 00:12:05,100 and and residencies and whatnot. 300 00:12:05,799 --> 00:12:08,754 Are you facing similar challenges, or are you 301 00:12:08,754 --> 00:12:10,355 not not seeing that as much in Puerto 302 00:12:10,355 --> 00:12:12,514 Rico? It sounds like you've got a fantastic 303 00:12:12,514 --> 00:12:14,434 team there, a ton of growth. Are you 304 00:12:14,434 --> 00:12:17,315 looking to attract any physicians from the Mainland 305 00:12:17,315 --> 00:12:19,075 or is it from Puerto Rico or you're 306 00:12:19,075 --> 00:12:20,695 kind of casting a wide net? 307 00:12:22,559 --> 00:12:23,459 Yeah. Basically, 308 00:12:24,319 --> 00:12:25,779 I think that Puerto Rico 309 00:12:26,399 --> 00:12:28,159 is the same as The States. I mean, 310 00:12:28,159 --> 00:12:30,559 we are we are suffering because we need 311 00:12:30,559 --> 00:12:31,059 more, 312 00:12:31,600 --> 00:12:34,500 specialized care and and, of course, more surgeon. 313 00:12:34,794 --> 00:12:37,934 I think we are lucky that, our physicians 314 00:12:38,315 --> 00:12:41,054 train basically on the state universities 315 00:12:41,835 --> 00:12:44,394 and they they they want to come back 316 00:12:44,394 --> 00:12:45,455 to Puerto Rico. 317 00:12:45,835 --> 00:12:47,995 And like they want to come back to 318 00:12:47,995 --> 00:12:49,995 Puerto Rico, one thing that I will say 319 00:12:49,995 --> 00:12:52,040 that has been easy for us 320 00:12:52,420 --> 00:12:53,160 is that 321 00:12:53,540 --> 00:12:55,000 surgeons are already 322 00:12:55,379 --> 00:12:57,240 used to train in this ambulatory 323 00:12:57,620 --> 00:13:00,259 surgical setting. And they would when they come 324 00:13:00,259 --> 00:13:01,480 back to Puerto Rico, 325 00:13:01,860 --> 00:13:04,245 they are super excited that they can have 326 00:13:04,404 --> 00:13:07,125 the type of facility that they train in 327 00:13:07,125 --> 00:13:09,605 Puerto Rico. Because, you know, that, 328 00:13:10,725 --> 00:13:12,565 it was there there there are not that 329 00:13:12,565 --> 00:13:15,524 many surgical centers in Puerto Rico. Basically, all 330 00:13:15,524 --> 00:13:16,745 the centers are 331 00:13:17,190 --> 00:13:19,669 almost single specialty. There is a lot of 332 00:13:19,669 --> 00:13:20,410 eye centers, 333 00:13:21,350 --> 00:13:21,850 urology, 334 00:13:22,470 --> 00:13:22,970 gastroenterology. 335 00:13:23,750 --> 00:13:26,149 But mostly specialty centers, there are not that 336 00:13:26,149 --> 00:13:27,210 many. So, 337 00:13:28,470 --> 00:13:30,710 seems to be difficult, but for us has 338 00:13:30,710 --> 00:13:32,115 been a blast that the doctors 339 00:13:33,154 --> 00:13:34,455 really want to come 340 00:13:34,995 --> 00:13:36,214 back to Puerto Rico and that are already 341 00:13:36,434 --> 00:13:37,955 has been used to train in this type 342 00:13:37,955 --> 00:13:38,615 of facility 343 00:13:39,235 --> 00:13:40,054 in The States. 344 00:13:40,674 --> 00:13:42,434 Yeah. I just recently had a a trip 345 00:13:42,434 --> 00:13:44,514 to San Juan and absolutely loved it. The 346 00:13:44,514 --> 00:13:46,355 people, the culture, the food, so I can 347 00:13:46,355 --> 00:13:47,940 see why they wanna come back. 348 00:13:48,740 --> 00:13:51,480 Angie, it's been We are in paradise. Remember? 349 00:13:53,139 --> 00:13:55,879 We are in the tropical weather. No no 350 00:13:56,019 --> 00:13:58,179 no snow. You know, it's it's it's a 351 00:13:58,179 --> 00:14:00,980 blessing living here. Yes. Yeah. Yeah. I know 352 00:14:00,980 --> 00:14:03,975 they'll be back sometime soon. Angie, I really, 353 00:14:04,035 --> 00:14:05,095 really appreciate, 354 00:14:05,554 --> 00:14:06,995 you taking the time to speak with us. 355 00:14:06,995 --> 00:14:08,375 It's been a fascinating conversation. 356 00:14:09,154 --> 00:14:11,075 Sounds like a ton of exciting things coming 357 00:14:11,075 --> 00:14:13,075 down the line for you and your team. 358 00:14:13,475 --> 00:14:15,394 Congratulations on all your hard work, and I 359 00:14:15,394 --> 00:14:16,995 look forward to catching up with you again 360 00:14:16,995 --> 00:14:17,815 down the line. 361 00:14:18,408 --> 00:14:19,708 Sure. Thank you.